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PFI2021-00347 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT NI s COMMUNITY DEVELOPMENT Permit#: PF12021-00347 Date Issued: 09/28/2021 T 16 A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: SEG524 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Job#M2909817 Project Description: SEG 524/PGE to repair loose wire between poles 5008 and 15227 Class of Work: FEES Type 1 -Utilities (gas, electric, data) Description Date Amount PFI Permit Fee 09/28/2021 $300.00 Total $300.00 Owner: REQUIRED INSPECTIONS Call 503-639-4175 for the IVR inspection request line or visit the City of PHONE: Tigard website at www.tigard-or.gov to schedule inspections online. Contractor: PHONE: Applicant: BRIANA FOGH 2213 SW 153RD DR. BEAVERTON, OR 97003 PHONE: 5037186349 Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact information of responsible parties before beginning work. Permittee/Applicant Signature: I vO r 1t See gapplication(� Issued By: O '- Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PFI2021-00347 Type: Condition Name: Status: Severity: PFI_Utilities 01 -WORK SITE REQUIREMENTS Applied Notice Applicant must comply with all applicable provisions of federal and state law,the Tigard Municipal Code, and the terms of any agreement with the City of Tigard regarding work to be done pursuant to this permit. PFI_Utilities 02-WORK SITE AREA Applied Notice The work area and approach roads shall be maintained in a clean condition,free from obstructions and hazards. The spreading of mud or debris or storage of materials or equipment of any kind upon any public roadway is strictly prohibited and violation shall be cause for immediate cancellation of the permit. The City may at any time order immediate clean-up and suspension of work to accomplish clean-up. PFI_Utilities 03-WORK SITE EROSION CONTROL Applied Notice Prior to starting work, effective and approved erosion control devices must be installed and maintained meeting the Clean Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to accomplish effective erosion control. PFI_Utilities 04-WORK SITE REPAIRS Applied Notice Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes, etc. shall be reinstalled or replaced,with like kind of material. Obtain City approval of restoration work. PFI_Utilities 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices [MUTCD]for Streets and Highways", U.S. Dept. of Transportation, FHWA, current edition,American Traffic Safety Services Association [ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH]. PFI_Utilities 06-TRAFFIC CONTROL PLAN Applied Notice Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work area. Traffic control devices,flag persons,etc., shall be in place prior to initiation of construction work and shall be effectively maintained. PFI_Utilities 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice Public roadway shall not be closed to traffic, at any time,without obtaining written approval from the City Engineer. The applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and area wide Emergency Services: 503-629-0111 (Tigard Police Dept., Tualatin Fire& Rescue)and to 503-962-8140 (Tri-Met) and 503-431-2345(Tigard School District)and other service providers impacted by such closure. PFI_Utilities 08-TRAFFIC CONTROL ADVANCE WARNING Applied Notice Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign at each end of the construction area 72 hours(min.)before initiation of construction work. PFI_Utilities 09-TRAFFIC CONTROL PROPERTY ACCESS Applied Notice Access to existing properties shall be maintained at all times, including normal delivery service and mail service. Obtain City approval of any access closures. PFI_Utilities 10-TRAFFIC CONTROL WORK HOURS Applied Notice Work is permitted in daylight between the hours of 7:00 a.m. to 7:00 p.m. Mon-Fri unless otherwise authorized by the City. PFI_Utilities 11 -TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m.to 9:00 a.m. unless authorized by the City Engineer. PFI_Utilities 12-TRAFFIC CONTROL MODIFICATION Applied Notice The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to assure public safety. PFI_Utilities 13-DRAINAGE CONTROL Applied Notice Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective drainage control. PFI_Utilities 14-UTILITY NOTIFICATION Applied Notice Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR 952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987. If you have any question about the rules,contact the Center. NOTE: Damage to utilities shall be corrected at the permit holder's expense. PFI_Utilities 15-UTILITY LOCATION CONFLICT Applied Notice Applicant must verify all existing utilities for both vertical elevation and horizontal location prior to start of work(pothole before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at the applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work with affected utility agencies. PFI_Utilities 16-TEMPORARY PATCH Applied Notice A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is liable for hazards or damage resulting from the prosecution of the work. PFI_Utilities 17-REPAIR OF EXISTING FACILITIES Applied Notice Work under this permit shall include repair of existing facilities (roads, ditches, etc.)as may be necessary, as determined by the Inspector,to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit. Corrective work shall be done at the applicant's expense. PFI_Utilities 19-PRECONSTRUCTION MEETING Applied Notice Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert Phone#>, to establish a preconstruction meeting. PFI_Utilities 20-NOTICE TO COMMENCE WORK Applied Notice The applicant shall notify the City's Inspector twenty-four(24) hours prior to commencing work, prior to any staged inspection, and after completing work covered by the permit. PFI_Utilities 21 -PERMIT/PLAN ON SITE Applied Notice A copy of the permit including a Certificate of Insurance, and all attachments, and a copy of the approved construction plan and all amendments shall be readily available at the work area. All work shall conform to the permit terms,conditions and provisions and to the City approved permit plans, and approved plan amendments and to the City's standards and specifications and to these General Conditions. Changes to any of these must be approved by the City, in advance of work performance. PFI_Utilities 22 -DAILY INSPECTION REPORTS Applied Notice Applicant shall submit daily inspection reports, on a weekly basis,to the City's Inspector. PFI_Utilities 23-MONUMENT PROTECTION Applied Notice Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's expense. PFI_Utilities 24-VALIDATION OF MATERIAUCONSTRUCTION Applied Notice The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense. PFI_Utilities 25-EMERGENCY CONTACTS Applied Notice Provide to the City inspector, in writing,the names and 24 hour emergency telephone number of two(2) persons who have authority to resolve problems,take corrective action and, in general,will be responsible in case of any emergency. The applicant shall notify the City Inspector, in writing, of any/all assignment changes. PFI_Utilities 26-RIGHT OF ENTRY/EASEMENTS Applied Notice Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to obtain or provide for proof of right-of-entry or easements. PFI_Utilities 27-PRIVATE PROPERTY AGREEMENTS Applied Notice Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction activity. PFI_Utilities 28-AS-BUILT DRAWING Applied Notice 1,2,3,4,5 28 -AS-BUILT DRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). 1,2,3,4,5 28-AS-BUILT DRAWING One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and,also, any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). One as-built drawing showing all new public improvements, including any revision made to the previously approved construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of Compliance). City of Tigard PFI#: PFI2021-00347 S , ENGINEERING DEPARTMENT TIGARD Public Facilities Improvement (PFI) Permit PROJECT INFORMATION PGE Job # M2909817 TYPE OF WORK Project name: la TYPE 1—Franchise utility Work Brief description of project: PGE to repair loose wire between performed by NWN,PGE, of utility agency poles 5008 & 15227 El TYPE 2—ROW Sidewalk/Driveway/Scwcr SEG 524 Work performed for the purpose of: • Sidewalk installation or repair • Driveway approach installation and repair SITE INFORMATION • Sanitary sewer lateral installation and Location (address if available): 9375 SW NORTH DAKOTA ST main line tap ❑ TYPE 3—Full Scale Development Work Tigard, OR 97223 performed with land use approval which includes any of the following: • Subdivisions or Partitions APPLICANT INFORMATION • Street widening Name: PGE [Briana Fogh for Jason Moxley] • Mainline installation for sanitary sewer, storm sewer, Tigard water, and Tigard Mailing address: 2213 SW 153rd Dr water service area City/State: Beaverton Gip: 97003 ❑ TYPE 4—Small Cell Technology Phone: 503.463.4355 ❑ TYPE 5—Tigard Triangle Crewcoordination-western@pgn.com Email: Phone: NOTE: Type 1 and 2 applications may be 503.718.6349 emailed to rowpermits(tltigard-or.gov. Contact name: Phone: Jason Moxley Email: Crewcoordination-western@pgn.com CONTRACTOR INFORMATION I] Same as applicant Name: CCB Number: Mailing address: City/State: Zip: Phone: Email: ENGINEER INFORMATION Name: Mailing address: City/State: Zip: Phone: Email: ADDITIONAL INFORMATION Estimated value of work is required(if over$5,000):$ (within the public right-of-way) Is work related to a LAND USE DECISION? Dyes ElNo Case number: City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of 4 APPLICANTS NOTE: Person specified as "Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if required by the city pursuant to TMC 15.04.140. * With the exception of a utility operating pursuant to a valid franchise or license with the City of Tigard,when the owner and the applicant are different people,the applicant must be the purchaser of record or a lessee in possession with written authorization from the owner or an agent of the owner. The owner must sign this application in the space provided or submit a written authorization with this application. Franchised or Licensed Utilities are not required to obtain the owners signature on the application. I,the applicant,certify that: • To the best of my knowledge, all the information provided within this application package is complete and accurate. • The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject property. • If the application is granted,I will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. Briana Fogh 9/22/2021 Applicant's or authorized agent's signature Print name Date Property owner's signature (if required) Print name Date STAFF USE ONLY PFI2021-00347 NT 9/22/21 Case No: Permit fee: • 300 Received by: At.- Date: Approved by: �/P.4/7/ Date: t/2Fr'�2o A 2/ Notified by: .. Date: otlEs.(2.021 City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement(PFI)Permit: INITIAL PFI PERMIT FEE Part 1: Required submittal fee is 10%of the Net PH Permit Fee.See below for calculations.Minimum of$300. NET PFI PERMIT FEE Part 2: All non-water system improvements engineer's estimate X 7% (less the initial PH Permit Fee). WATER LINE CONSTRUCTION FEE Part 3: All public water system improvements engineer's estimate X 12%. FOR STAFF USE ONLY FOR STAFF USE ONLY TYPE 4: SMALL WIRELESS FACILITY TYPE 1—3:DETAILED SUBMITTAL CHECKLIST REQUIREMENTS Does applicant have a right-of-way license? 0 Yes 0 No TYPE 1 AND TYPE 2-Must include a sketch showing: Under the wireless facilities standards,is the proposal ❑ Dimensions considered?(check all that apply): ❑Small Cell 0 Macro ❑ Street Name ❑ Site Address How many install sites are proposed as part of this permit application? TYPE 3-Must provide 4 sets of plans (sized 24 x 36 or 22 x 34) and an electronic version of all submittal The proposed equipment is located on which of the following: items. The plans must that include: ❑Public Right-of-Way 0 Private Property ❑ Cover—Site,Vicinity,Abbreviation,legend If equipment is to be located on private property,describe the ❑ General Notes(City,Water,Sewer,etc.) type&use: ❑ Street(Plan,Profile) ❑ Water,Storm and Sanitary(Plan Profile) ❑ Water Quality Facilities ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utility Plan(Electrical,Phone,Gas, Storm, Sanitary,Water,Signage,Street Lights,etc.) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label(project land use name,revision and plan log block,dates and sheet numbers.) ❑ Engineer's Construction Estimate Additional Submittals (per land use conditions,if applicable) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design ❑ Water Provider Approval City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 3 of 4 eo 802 LEGEND on 11130 • ; 11100 U • SURVEY GRID BOUNDARY , 80200 1' _ 30 2406E 0); REMOVEIARANDON FACIL,T!50 INSTALL FACILITIES I 20'4 16425 • Mil MODIFY/TRANSFER/INSTALLADOIIIONAL FACILITIES 1977 — U POLES j POLE CLASS(1,2,3,4,HI,H2,S) t 111ao hneD om q 5a E HT-CL n1 c§ tt1' K x •"—"a'�- ! o_ q POLE HEIGHT •' - — m 3 FRAMING TRANSMISSION&OISTRI800ION(SEE CODES BELOW) _ II 20d r 1982 Ni 0 9375 Ia' ki o 9oD5 Taas a 9293 00 CREW NOTES: 5008 m II 58 9205 LOOSE LASHING WIRE NEEDS TO BE REPAIRED 152 ® ® 95 80222 51 45-3 a, 4582 • FROM FL#SODS TO PL415227 45 _ 8021Q `.11.�i� 2Dd 0'd 1W4 CN 2 ACSR - '5 -- - 1B]] 1 _ m 1954 143 11, 1. 50 °_• 50 24876 143 10 T '� - BN2ACSR _ ._._-.... 92AL 1 UIQ S ORTH DAKOTA S `�' —8 2ro AL-TX yly B 25 84782 2550111 �h G ___ a 9F.8B ay, K i ...,. T_— _.. y5•y F �� 1 9460 1'245 24,. ? 8322 4444 2015 1 _. 80212 ' 1 a = 217 B U I q l' 1 D / p 3 1iOALTX y5.-4 11'B 25 87316 N[rd �^y'�q ggg 2 SILT%— 1 I E01111 °z A 75 O6 G 11285 _.�? Dew '., 11275 ag z JJJ 41 — 0 3$ 70 :c 140 Fet w x VICINITY MAP r. PROGRESS SW Locust St /HINK AS BUILT VER CONSTRUCTION VIOLATIONSCORRECTED SW Mann-I.aIS, SAFETY INGA!!QIN E NI=S L VIQLF�I ,.n:`..'..., SW Gat St Foreman: Date: SW PIn.sI \IRST General Foreman: Gate: sw Sr.i..51 (SHAM.•HWY ANAreC for INN walvdmn changes.) WEST PORTLAND SOPA4£NG RtVIEW SBUR.T BY DESIGNER: -IN sat'nauoa.. I T -- -- LATE -SCALE: ACCOUNT AWO.. JOB NO - sq. < ANY DEVIAATION FROM THIS DESIGN MUST 8/16/2021 1in=70ft 1070001 0000017443 M2909817 F`P °' 6EAPPROVED BY7HE PGE PROIECTMANAGER INLE07-2020 OH FITNES REPLACE SECONDARY CONDUCTOR ATTENTION ZE CALL 811 BEFORE YOU Difl /` ODRNELL-WESTLAWN UT S 11 X 17 - SH'nmlmmltn5 ORFGONLAW REQUIRES YOU TO FOLfOW RULES ADOPTED LOCATION TIGARD BY THE OREGON UTILITY NOTIFICATIONCENTER 9 �� 93755W NORTH DAKWIR ST,TGARD 97223sw w,mw%' THOSE RULES ARE SET FORTH IN OAR 952.001.0010 ®^y■ DESORtFRoNLASHING WIRE REPLACEMENT/REPAIR @ POLE Ue • THE RULE 951-D01-0090 YOUMAY OBTAIN COPIES OF `� ` C113SE$B08 SHEET \42. THE RULES BY CALLING TIE OREGON UTILITY COUNTY SECTIONS WORK WITH lwsa,,,.,s1 Sources'Esr..HERE.Gaiminl US me map lNCHtltt`- TORENOTIFICATION CENTER ADMINISTRATION LOCATES STRATNMIp(502-232-1981) WASHINGTON C1135D 10F1 P NRCan.E Japan.NET[Esn CD a 5no Kong).[SrO REQUEST UTILITY LOCATES CALL THE OREGON Itmx•Wha1511810W. BEAVERTON ASIGNBY PHONE DRAWN BY Korea Esri(ThailanH).NGCC r,rr oi'1rrl.1.o mnv UTILITY NOTIFICATION CENTER,811 AT LEAST ��before you dig. ura=.caeca cavrea JASON MOXLEY 503.718.6349 Christian SDhumanl.CUAiS and the.GIS Ueee11BOhmunity 2 BUSINESS DAYS PRIOR TO EXCAVATION ,j,'vnm ',,,Wan 0 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED Y SIv " Y '• SI Edge of Pavement . Ditch �► Streetlight •—•—•—•—• —�—•— +• Rain Drain. f1..e" i II 1 • T—'Frro'p'orecr tivet'Ci 1 -- ht.l I I • i Ni I Existing House aI Existing 1 �I >i Driveway 9` I 1 e , c' -• . Lt7 iiiII •-1 I • v 1! t! I y® I ;i A 1 1 ° Existing Shop Powerpole • t11 > c11 95' I I O �ioperty Line— 0 I Fire Hydrant(FH) Scale: 'I"=30' i I i I i I 1 TYPE 1 AND TYPE 2: MINIUM SKETCH REQUIREMENTS (Put N/A if not applicable) North arrow Property lines&dimensions Existing utilities locations (sewer,storm,water) Street&street names All existing structures Proposed work Existing curb or edge of pavement Utility&street light poles Existing S/W or D/W apron Slope of property Trees City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 4 of 4 www.invarion.com Lane Closure at Intersection with Flagging Diagram 620 ROAD WORK AHEAD ONE LANE C I 4 t (Optional) ROAD t AHEAD B BE ' PREPARED A TO STOP B 41111> A ` (Optional) I 1 • 0 ONE LANE ROAD O 40 BE AHEAD 100 R.Max. PREPARED ROAD 0 WORK i TO STOP AHEAD O � Ag6Ci Buffer O 0 O O O O 0 rizm O y o 0 • O rmo K K K K4 O - . - + 100 ft.Max. C B B q IROADO BE WORK PREPARED o 100 ft.Max. AHEAD TO STOP O ONE LANE ROAD 0 AHEAD • (Optional) A 10 B BE e PREPARED TO STOP B (Optional) ir ONE LANE 4 t C ROAD AHEAD ROAD WORK AHEA. www.invarion.com Lane Closure at Intersection with Flagging Diagram 620 Diagram 620 covers work within an intersection when normal traffic control must be interrupted. Work vehicles may or may not be in the work space. 1 . During flagging, traffic signals shall be turned off. Contact the road jurisdiction for approval and assistance (see Chapter 3). 2. For multi-lane facilities, traffic approaching the intersection shall be reduced to a single lane on each approach. See Chapter 3 for information on flagging through intersections. 3. There should be one flagger for each approach. One flagger may control two adjacent approaches if sight distance, low volumes on side roads, and flagger position allows for safe operation and clear direction to motorists. For low traffic volume intersections (fewer than 400 entering vehicles per day), one flagger may be used. 4. The "ONE LANE ROAD AHEAD" (W20-4) sign is optional and should be considered on high volume or high speed roads, or when extended queues may be expected. Sign Spacing and Buffer Lengths (feet) Posted Spacing Between Signs Buffer Speed A B C Space ERRATA: 20 50 25 100 100 100 75 Supplement Table 30 100 35 350 350 350 125 Updated: February 12, 40 150 2016 45 180 By:ODOT Traffic•Raodway 50 500 500 500 210 Section 55 250 Signs Spacing and Buffer Lengths (feet) Supplement Posted Spacing Between Signs "Buffer" Speed A B C Space 60 285 65 700 700 700 325 70 365 www.invarion.com Bicycle Accomodation Diagram 5-6 NOTES: - Bicycles on Roadway (CW11-1) sign should not interrupt standard sequences. For example: - BE PREPARED TO STOP/Flagger Symbol - LANE CLOSED AHEAD/Lane Ends WorkSymbol - Bicycles on Roadway sign typically follows ROAD Area WORK AHEAD sign and used as general warning. A 7 A I B It A ON ROADWAY I C I ROAD WORK AHEAD www.invarion.com Bicycle Accomodation Diagram 5-6 Bicycle Accommodation Principles: 1 . If a significant volume of bicycles can be expected and work closes a marked bicycle facility, or requires bicycles to share a travel lane, install a "(Bicycle) ON ROADWAY" sign (CW11-1) or the Bicycle symbol (W11-1) sign with an "ON ROADWAY" (OBW1-5) rider, in advance of the work area. 2. Install temporary signing off the paved shoulder, within the planter (buffer) strip, or share the width needed between the shoulder and the sidewalk, as available. 3. Signs are to remain in place until the surface is restored and the width made available for bicycle use. See Diagram 5-6 for typical bicycle signing placement. Sign Spacing and Buffer Lengths (feet) Posted Spacing Between Signs Buffer Speed A B C Space 20 50 -- 25 100 100 100 75 ERRATA: 30 100 Supplement Table 35 125 350 350 350 40 150 Updated:February 12, 45 180 2016 By:ODOT Traffic-Roadway 50 500 500 500 210 Section 55 250 Sign Spacing and Buffer Lengths (feet) Supplement Posted Spacing Between Signs "Buffer" Speed A B C Space 60 285 65 700 700 700 325 70 365